Meibomian Gland Dysfunction, Dry Eyes & Blepharitis


 Meibomian Gland Dysfunction/Dry Eye/Blepharitis


Dry eyes are a very common but potentially debilitating condition. There are many causes of dry eye but by far and away the most common cause is Meibomian Gland Dysfunction. 

Healthy tears are vital to your eyes functioning correctly.  Your tears are a very important part of your eyes, immunity, cleaning system and optical pathway.  When your eyes are dry you may experience:

  • Painful, sore gritty eyes
  • Blurred vision
  • Recurrent corneal infections or erosions
  • Persistent eye “fatigue”
  • A pressure feeling behind the eyes
  • “Watering” eyes


What is Meibomian Gland Dysfunction?

Meibomian Gland Dysfunction (MGD) is sometimes also called blepharitis.  Generically, it refers to inflammation of the eyelids and is by far the most common cause of dry eyes.  It can lead to red, flaky skin on the eyelids and sore, red, gritty eyes.  Often patients will feel as though their eyes are stuck together in the morning due to the sticky deposits on their lids and lashes.  Blepharitis leads to dry eyes by reducing the quality of your tears and leading to dry patches on the surface of your eye. 


Each eyelid contains a row of meibomian glands.  Their job is to secrete the very important oil layer of the tears.  In MGD, the secretions from the meibomian glands become thick and viscous so not enough is secreted in the tear film.  This creates an imbalanced and unhealthy tear film that is ineffective in moisturising the eyes and leads to dryness, blurred vision, redness and pain.


There are three important layers in our tears.  They must all be present in balanced quantities for our tears to effectively moisturise the eyes.  The innermost layer that sits against the cornea is the mucin layer.  Next is the aqueous layer.  This is made of water and is secreted by the lacrimal gland.  It is very rare for this gland to function abnormally. 


The layer of tears that is deficient in MGD is the outermost layer.  This layer is made of oil, which is secreted by the meibomian glands.  The meibomian glands are located in the upper and lower eyelids.  Treatment of your meibomian gland dysfunction will help to restore all of the layers of the tear film to a normal healthy state so that you can return to having comfortable eyes again. 




Intense Pulsed Light “IPL”

IPL stimulates the meibomian glands to create a healthier and thicker oil layer for the tears. This leads to a significant reduction in dryness and an improvement in redness, pain and vision.

The treatment is repeated after 2 weeks, 1 month and then monthly until symptoms have resolved. Sometimes a “top-up” treatment may be required a few months later.The treatment is painless and no needles or injections are required. Four or 5 gentle applications of the laser are applied to each lower eyelid, you will feel a “warmth” on the cheeks and lids. Your eyes will be covered with a pair of goggles to protect them from the bright light.  Afterwards, a drop of local anaesthetic will be instilled into your eyes.  This will allow a firm squeezing of your eyelids to express some meibomian gland fluid out of your meibomian glands. 

You must NOT wear make-up or sunscreen to your appointment when having IPL but you may put it on after the treatment. 


Meibomian Gland Probing

Meibomian gland probing and expression is a procedure to unblock the small obstructions and fibrosis that are blocking your meibomian glands and causing their dysfunction.


The procedure is performed in the clinic at Queensland Eye Institute.  You will be sitting in a normal chair in the consultation room.  Dr Cronin will inject some local anaesthetic and an anti-inflammatory steroid around your eyelids to make them numb and ensure they do not become inflamed afterwards.  Sometimes you may develop a small amount of bruising from the injections.  A specially designed pair of forceps gently squeeze your lids while the ultra fine probe unblocks each of the meibomian glands.  The procedure takes approximately 15 minutes.  You will be able to drive home afterwards.  The injection into the eyelids does sting slightly, but this is very short-lived.  The procedure does not hurt and is very well tolerated by patients.


Omega-3 capsules

Taking a high dose of Omega-3 oils (such as fish oil) significantly helps MGD and other dry eye conditions.  There are two important benefits.  The essential fatty acids in Omega-3 capsules are important in producing potent anti-inflammatory prostaglandins.  This anti-inflammatory effect reduces the inflammation that occurs in blepharitis and other dry eye conditions.  The high dose of Omega-3 fatty acids also improves the health of the oil secreted by the meibomian glands.  This leads to a healthier and more effective tear film and more comfortable eyes.

High doses of Omega-3 fatty acids are required to achieve a significant improvement in MGD and dry eye.  General pharmacy bought fish oil capsules are rarely potent enough to help dry eye.  Dr Cronin will suggest an appropriate brand and dose depending on the severity of your condition. 


Dry Eyes Make Eyes Dryer

When your eyes are dry, the tears become too salty.  This high salt concentration can damage some of the cells that help to produce tears, thus making your eyes drier.  It is important to use lubricating drops to reduce the salt concentration and break this cycle so that your eyes can have a chance to recover and return to a healthy comfortable state.                                                            


Drink more water

Remember that if you are dehydrated, your eyes will be as well.  So make sure you drink plenty of water and avoid excessive tea and coffee. 


Control your environment

The environment around you plays a very important role in dry eye treatment.  Wind, fans, cold air-conditioning and warm heating all have a drying effect, which means that you will have excessive evaporation of your tears.  Increasing the relative humidity and protecting your eyes from the direct flow of air will reduce the evaporation of your tears.  Just follow these simple steps -

  1. Wear glasses or wraparound sunglasses when outside in the breeze, this will stop the wind blowing directly into your eyes.  If you need spectacles, choose frames with thicker arms to “enclose” your eyes more and protect them from the wind. 
  2. Ensure you are not near a fan or air-conditioning vent.  The ‘gentle’ flow of air from heating or cooling systems is not gentle on your eyes – it can be very drying.  Create a barrier between your eyes and the flow of air by moving your chair or desk.  This is also important in your sleep as many people with dry eyes sleep with their eyes very slightly open.
  3. Go green! Consider using plants to raise the humidity in your work area.  Plants not only form a great barrier to stop the direct flow of dry air-conditioning air into your eyes, but they also raise the local humidity.  Pick water loving plants with nice big leaves as they will release more moisture into the air than a cactus!
  4. Make an oasis. Florists use a product called oasis or floral foam in flower arrangements.  It is great for creating a large surface area for water to evaporate and raise the local humidity.  Put some oasis into a bowl of water with most of the oasis sitting out of the water.  This will cause the water to evaporate and raise the humidity.  You can still put real or artificial flowers in the foam to make it look appealing.
  5. Avoid smoking and smoky environments.  

DRY EYES from Brendan Cronin on Vimeo.